Murohara T, Kamijikkoku S, Honda T
Division of Cardiovascular Medicine, Saiseikai Kumamoto Hospital, Japan.
Crit Care Med. 2000 Jun;28(6):1861-4. doi: 10.1097/00003246-200006000-00029.
Myocardial ischemia/reperfusion induces ventricular reperfusion arrhythmias (RAs). Significant parts of RAs are considered to be evoked by oxygen free radicals. Inasmuch as activated leukocytes release oxygen free radicals, and as the intercellular adhesion molecule-1 (ICAM-1) plays a major role in leukocyte infiltration, we examined whether there may be a relationship between plasma levels of soluble ICAM-1 (sICAM-1) and frequency of RAs in patients with acute myocardial infarction (AMI).
Prospective study comparing the two AMI patient groups with or without RAs.
Coronary care unit and cardiac catheterization laboratories in a general hospital.
Twenty-three AMI patients (eight women and 15 men, aged 32 to 79 yrs).
All patients received percutaneous balloon angioplasty with or without previous intracoronary thrombolysis. Significant RAs were defined as at least one of nonsustained ventricular tachycardia, multifocal premature ventricular contraction, and frequent premature ventricular contraction occurring >15 times/min, which were not observed before reperfusion.
Plasma sICAM-1 levels were measured using an enzyme-linked immunosorbent assay. The plasma sICAM-1 levels at admission were significantly greater in RA(+) (243 +/- 60 ng/mL) than RA(-) group (192 +/- 44 ng/mL) (p < .05). We followed plasma sICAM-1 levels up to 3 wks, and found that sICAM-1 levels were consistently higher in the RA(+) than the RA(-) group. Simple regression analysis showed no significant relationship between plasma sICAM-1 levels and age, systolic and diastolic blood pressures, or serum creatine kinase activity. The two AMI groups showed no differences in age, gender, events of major coronary risk factors, preinfarction angina, and medication.
The increase in the plasma levels of sICAM-1 was observed in patients manifesting ventricular RAs. This increase in sICAM-1 levels was observed as early as at admission. The increased plasma sICAM-1 levels may be a useful biochemical marker for predicting myocardial reperfusion injury such as RAs in AMI.
心肌缺血/再灌注会诱发心室再灌注心律失常（RAs）。RAs的很大一部分被认为是由氧自由基诱发的。鉴于活化的白细胞会释放氧自由基，且细胞间黏附分子-1（ICAM-1）在白细胞浸润中起主要作用，我们研究了急性心肌梗死（AMI）患者血浆可溶性ICAM-1（sICAM-1）水平与RAs发生频率之间是否存在关联。
比较有或无RAs的两组AMI患者的前瞻性研究。
一家综合医院的冠心病监护病房和心脏导管实验室。
23例AMI患者（8名女性和15名男性，年龄32至79岁）。
所有患者均接受了经皮球囊血管成形术，部分患者此前还接受过冠状动脉内溶栓治疗。显著RAs定义为再灌注前未观察到的至少以下之一：非持续性室性心动过速、多灶性室性早搏以及室性早搏频发（每分钟超过15次）。
采用酶联免疫吸附测定法测量血浆sICAM-1水平。RA（+）组入院时血浆sICAM-1水平（均值243±60 ng/mL）显著高于RA（-）组（192±44 ng/mL）（p<0.05）。我们对血浆sICAM-1水平进行了长达3周的随访，发现RA（+）组的sICAM-1水平始终高于RA（-）组。简单回归分析显示血浆sICAM-1水平与年龄、收缩压和舒张压或血清肌酸激酶活性之间无显著关联。两组AMI患者在年龄、性别、主要冠状动脉危险因素事件、梗死前心绞痛及用药方面无差异。
在出现心室RAs的患者中观察到血浆sICAM-1水平升高。这种sICAM-1水平的升高在入院时就已出现。血浆sICAM-1水平升高可能是预测AMI中RAs等心肌再灌注损伤的有用生化标志物。
